Archive for May, 2015

The Pre-Memorial Day Edition of Health Wonk Review

Thursday, May 21st, 2015


We’re just a few short days away from Memorial Day, a time to remember those who died while serving in the country’s armed forces. It’s also the tail end of National Physical Fitness and Sports Month so our prescription is to get your fill of health wonkery here today, but then kick off a little early tomorrow. Find some time to pay your respects this weekend and then get out there and get active. All wonk and no play leads to Type 2 Diabetes.

OK, here’s this week’s roundup of wonkery:

Joe Paduda tells us that 21 states have not (yet) chosen to expand Medicaid. In his post at Managed Care MattersMedicaid and Workers’ Comp — he explains the impact that decisions to expand / not to expand have on workers’ comp patients, premium payers, and insurers.

At Colorado Health Insurance Insider, Louise Norris offers her thoughts on the Luis Lang story. Don’t know his story? She points to a number of media stories, including an interview with Henry Pollack. She says that the interview is an excellent look into how the law is perceived, particularly by those who are resistant to it based on their politics and their information sources. She notes that a year and a half after the first Obamacare open enrollment period began is testament to the fact that there’s still an uphill battle in terms of getting accurate information out to the people who need it the most.

Emergency Department visits are up post-Obamacare and opponents are using that to bash supporters. But at Heath Business Blog, David Williams says, “of course emergency department visits are increasing” – and it’s not really fair to blame supporters, since many (including him) predicted that ED visits would rise, not fall. He reminds opponents that before Obamacare, many were bashing the uninsured for clogging up emergency rooms.

The FDA is generally concerned with efficacy and safety, but now does the FDA care about what patients think? A new draft guidance recommends measuring patient preferences for medical devices. Jason Shafrin at The Healthcare Economist investigates.

Despite the Genetic Information Nondiscrimination Act of 2008 (GINA), the issue of genetic testing in the workplace keeps resurfacing in one form or another. At InsureBlog, Henry Stern discusses the latest twist in his post Your Genes vs Your Job.

Indiana has recently become a place where health and politics intersect with striking consequences: One of the largest outbreaks of HIV ever identified in the U.S. continues to unfold in the state writes Preeti Malani, a Professor of Medicine in the Division of Infectious Diseases at the University of Michigan She says that needle exchanges and substance abuse counseling and treatment are crucial in fighting HIV. See her post at Health Affairs Blog: Allow Evidence, Not Politics, To Drive Prevention: Lessons From Indiana’s HIV Outbreak.

Over at the newly designed HealthBlawg, David Harlow reacts to Overkill, Atul Gawande’s recent New Yorker piece on the problem of over-diagnosis and over-treatment. David offers a prescription for an approach to eating the elephant in his post: An avalanche of unnecessary care.

Could healthcare be much more efficient – ie lower cost and higher quality – if we were to leverage the full potential of information technology? Peggy Salvatore says we are oh-so-close to being there. In her post at Health System Ed, she talks to Dr. Sandeep Pulim, the CMIO,of a company that developed an application that is pulling all the pieces together.

Trade negotiations may be unfamiliar territory to those interested in addressing health care dysfunction, but Roy Poses explains why it shouldn’t be in his post at Health Care Renewal. The new trade pacts under recent senatorial dispute could potentially have major effects on health care and public health. They allow for the creation of international tribunals, which lack the sorts of due process and accountability of court systems in most developed countries, but which could be used to fight national health and safety regulations. Learn more: All the President’s Trade Negotiators – Revolving Doors, Regulatory Capture, and Health Care Corporate Friendly Trade Agreements

Charles Gaba says that with the May 15 start of the 2016 rate review season, we should expect to start seeing stories with scary-sounding headlines in on- and off-line media. Pre-emptively, he lets the air out of rate-increase hysteria in his post at blog. (We note that in addition to being a contributor there, Charles is the proprieter of, which tracking enrollments for the Affordable Care Act.

Here at Workers Comp Insider, we look at the “State of the Line” for the workers comp industry, as depicted in the release of several key indicators issued and discussed by NCCI at the recent Annual Symposium. How are things looking? Calm for now, but turbulence ahead.

NCCI “State of the Line” for Work Comp

Wednesday, May 20th, 2015

At its Annual Issues symposium held last week, NCCI offered it’s State of the Line, an overview of the health of the work comp industry. The press release NCCI offers a summary:Calm Now … But Turbulence Ahead Outlook for Workers Compensation Industry. For more detail, see Chief Actuary Kathy Antonello’s presentation slides (PDF) reviewing workers compensation trends, cost drivers, and the significant new developments shaping the industry. And for other presentations and reports, see News from the Annual Issues Symposium 2015.

Some of the report highlights:

  • The workers compensation calendar year combined ratio for private carriers was 98 in 2014, a four-point decrease from 2013 and a 17-point decline since 2011
  • Total market net written premium increased by approximately 6% to $44.2 billion, driven primarily by an increase in payroll
  • Claim frequency declined 2% in NCCI states
  • Claim severity increased slightly more than inflation measures for indemnity and medical costs
  • While workers compensation premium volume continues to increase, construction and manufacturing employment totals remain well below prerecession levels–restraining even higher premium growth rates
  • A continuing low-interest-rate environment threatens investment results over the long term
  • Last year marked the fourth consecutive year of workers compensation residual market premium growth. Premiums grew by approximately 7% in 2014, while the average market share in the residual market held steady at 8%

In addition, NCCI President Stephen Klingel added commentary on market turbulence:

“From ongoing threats to exclusive remedy, to the risk of benefit increases without appropriate rate adjustments, to the rapidly changing nature of our workforce and workplaces, our industry is being tried on all sides today. While I am confident that we will work our way through these challenges, it is important to be realistic about current conditions and to recognize that the current positive results may not last.”

For the next best thing to being at the symposium, it’s worth checking out Joe Paduda’s running commentary on the various NCCI sessions…

First up at NCCI – Work comp is looking better…

The State of the Workers’ Comp Line – 2015 ed.

Listening fast to Bob Hartwig

NCCI’s PM sessions – hard core research geeks only

Listening fast to Bob Hartwig

Another great source of conference blogging is Mark Walls at Safety National – who blogged not just this NCCI symposium, but many other industry events and reports too — if you don’t have Conference Chronicles bookmarked, you should!

Here are reports from some other media outlets

Stephanie Goldberg, Business Insurance
Turbulent times ahead for workers compensation

Andrews G. Simpson, Claims Journal
Workers’ Compensation Results Improved in 2014 But Industry Anxious About What’s Ahead

The Grumpy Cat Edition of Health Wonk Review

Friday, May 8th, 2015

You’d think with spring in the air, everyone would be in a better mood, but apparently not. Steve Anderson found there is “a general vibe of grumpiness out there in the health policy blogosphere” and he taps into it to bring you the Grumpy Cat edition of Health Wonk Review posted at his blog. Go find out what everyone is complaining about.

The next frontier in prevention: Mental Health

Wednesday, May 6th, 2015

May is Mental Health Month and while the focus of workers comp prevention generally revolves around issues of physical safety, perhaps employers should expend more energy in promoting the mental/emotional well being of workers, as well. We just had a dramatic example of the effects of mental illness in the workplace in the horrific case of the suicidal Germanwings pilot who crashed the commercial jet he was flying, resulting in 150 casualties. While this might seem an outlier, an extreme case, the workplace has all too many examples of violence resulting in injuries and death. Depression and mental health issues are a workplace reality and, on the whole, they aren’t being addressed all that effectively. This should be no surprise – society at large isn’t doing such a great job when it comes to mental health issues.

Mental Health America has designated this year’s Mental Health Month theme as a prevention/early intervention one: B4Stage4. They note that we need to change the way we think about mental health:

“When we think about cancer, heart disease, or diabetes, we don’t wait years to treat them. We start before Stage 4–we begin with prevention. When people are in the first stage of those diseases and are beginning to show signs or symptoms like a persistent cough, high blood pressure, or high blood sugar, we try immediately to reverse these symptoms. We don’t ignore them. In fact, we develop a plan of action to reverse and sometimes stop the progression of the disease. So why don’t we do the same for individuals who are dealing with potentially serious mental illness?”

Among the many steps to rectify this, MHA suggests Getting informed;
Getting screened and Getting help. The site has a plethora of communication resources, graphics and fact sheets that would help in an employer communication program.

Employers should Treat the individual, not the stigma.” That’s the advice from Terri L. Rhodes, Executive Director of the Disability Management Employer Coalition (DMEC) in a recent issue of Risk and Insurance. She cites the prevalence of depression in the general population at about 9 percent, according to the centers for Disease Control. This makes it likely that about 1 in every 10 workers is grappling with depression at some point in their work life.

Rhodes says:

Employers in particular need to become educated about recognizing signs and symptoms of depression and anxiety. This alone sends a powerful message that mental illness, like all illness, respects no title or position. Utilize the services of EAPs.”

She notes that while EAPs are an almost ubiquitous benefit, “they are woefully underutilized.” Managers should be trained in when and how to best use and refer to EAPs.

Mental health as a preventive issue is important, but it also an important consideration in post-injury recovery and return to work. An article in LexisNexis talks about post-injury depression as it relates to dealing with disabilities, the process of pursuing workers’ compensation benefits, and anxiety related to the ability to return to work.

The article cites the costs from a recent study on post-injury depression conducted by Abay Asfaw, Ph.D., and Kerry Souza, Ph.D., of the Centers for Disease Control and Prevention.

The study further quotes the determination of the Bureau of Labor Statistics that “after-injury depression costs workers, group health insurance plans and/or taxpayers at least an extra $8.2 million … within a 3-month study period in 2005 dollars. Such costs of treating depression as a sequel to injury are typically not included in estimates of the economic burden of occupational injury.” These numbers do not include related costs, such as inpatient care and prescription drugs.

Employers can play a significant role in fostering workplace mental health, both in the general work population and specifically with workers who are in post-injury recovery. Here are some resources for learning more.

Partnership for Workplace Mental Health – a program of the American Psychiatric Foundation in conjunction with various employers. It offers employer case examples, publications and services.

ACOEM’s Work Disability Prevention Guideline: “Preventing Needless Work Disability by Helping People Stay Employed

The Disability Management Coalition